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Cancer survivorship: Cardiovascular and respiratory issues

Bonnie Ky, MD, MSCE
Lavanya Kondapalli, MD
Daniel J Lenihan, MD
Section Editor
Patricia A Ganz, MD
Deputy Editor
Sadhna R Vora, MD


With the success of modern cancer therapy, cancer can be curable, and in cases where cure cannot be achieved, it can be treated as a chronic disease. As a result, there are now more than 15 million cancer survivors in the United States alone [1] and close to 30 million worldwide [2], and this number is expected to increase over time [3]. Given the growing population of patients once treated (or continuing treatment) for cancer, the medical community must learn how to best minimize the complications of cancer treatment.  

A growing population of adult survivors of both pediatric and adult-onset cancers are recognized to have an increased incidence of: 1) cardiovascular risk factors (hypertension, dyslipidemia, diabetes, obesity), 2) cardiovascular disease (coronary disease, valvular disease, cardiomyopathy, heart failure, and stroke) [4], and 3) pulmonary disease compared with the general population [5,6]. Epidemiologic data suggest that common cardiovascular risk factors are more strongly associated with risk of incident cardiovascular disease in cancer survivors as compared with noncancer controls [7]. Because of the potential for these conditions to result in a high degree of morbidity and mortality, understanding how to improve the prevention, recognition, and treatment of cardiovascular and pulmonary disease is an important priority to the overall health of this population.

This section will focus on the long-term cardiovascular complications encountered in cancer survivorship, and will also cover respiratory issues related to cancer therapy. Since there are a myriad of possible complications of cancer therapy [8], this section will summarize the most important and common cardiopulmonary conditions related to these systems. In each subsection, the diagnosis, treatment, and prognosis will be highlighted, if known, and areas where improvements in understanding are needed will be outlined. Finally, practical recommendations will be made for certain principles that may help guide the optimal treatment of cardiovascular effects in cancer survivors.

For readers who desire a broader overview of cancer survivorship, a separate topic that discusses these issues is available. (See "Overview of cancer survivorship care for primary care and oncology providers".)


Secondary to RT — It is well-established that radiation therapy (RT) is associated with an increased risk of coronary [9,10] and carotid artery disease [11-13]. This is believed to be secondary to damage to the microvasculature, which results in endothelial dysfunction, inflammation, oxidative stress, and accelerated atherosclerosis.


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